Endoscopic Ultrasound-Guided Pancreatic Fluid Collection Drainage and Pancreatic Ductal Drainage

Abstract

Peripancreatic fluid collections (PFCs) are common complications associated with acute and chronic pancreatitis. Symptomatic PFCs need drainage, and endoscopic ultrasound (EUS) is the current standard of care. Various factors like the size, location, presence of debris in the collection, and general condition of the patient drive the choice of technique for EUS-guided transmural PFC drainage. While plastic stents were initially used, specially designed lumen-apposing and biflanged metal stents have revolutionized therapy for pancreatic necrotic collections. Minimally invasive approach in the form of endoscopic necrosectomy is now established as part of the step-up approach for performing debridement. PFCs are also often associated with disconnected pancreatic duct, which is a difficult situation to manage with evolving evidence. Pancreatic ductal obstruction due to strictures and stones represent indications for endoscopic intervention with stent placement to reduce ductal hypertension. EUS-guided pancreatic duct drainage represents an alternative in patients where endoscopic retrograde cholangiopancreatography fails or is not feasible. Either transmural or transpapillary approaches have been described. In this review, we discuss the role of EUS in drainage of PFCs along with technical tips for the same. We also discuss in detail technical steps and accessories and provide a critical appraisal on evidence for EUS-guided pancreatic duct drainage.